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SCI Flashcards

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1
Q

Flexion injuries occur most often at which spinal levels?
Extension injuries occur most often at which spinal levels?
What are some other mechanisms for spinal cord damage?

A

C5-C6
C4-C5
axial loading and rotatory injuries

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2
Q

SCI will have a primary area of damage and then a secondary area that can…

A

extend multiple segments beyond initial segment

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3
Q

Anterior cord syndrome

A

compression of anterior portion or spinal artery
caused by cervical flexion
loss of motor function and pain and temp below lesion due to damage of corticospinal and spinothalamic tracts

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4
Q

Brown-Sequard syndrome

A

caused by stab wound
paralysis and loss of vibratory and position sense on the same side as the lesion because of corticospinal and dorsal column tracts.
loss of pain and temp on opposite side from spinothalamic tract
pure brown-sequard is rare

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5
Q

Cauda Equina injuries are below what level?
They are…
it is considered what kind of injury?
Characteristics?

A

L1
incomplete
peripheral nerve injuries
flaccidity, areflexia, and impairment of bowel and bladder function.
Full recovery is not typical due to distance needed for axonal regneration

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6
Q

Central cord syndrome

A

due to cervical hyperextension damages spinothalamic, corticospinal and dorsal columns.
UE present with greater involvement and greater motor deficits

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7
Q

Posterior cord syndrome

A

relatively rare
caused by compression to posterior spinal artery
loss of proprioception, two-point discrimination and stereognosis.
Motor function is preserved

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8
Q

ASIA Scale:
A

A

complete
no sensory or motor preserved in sacral segments S4-S5

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9
Q

ASIA Scale:
B

A

sensory incomplete
sensory function preserved below neurological level including S4-S5 AND no motor function preserved more than 3 levels below on either side

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10
Q

ASIA Scale:
C

A

Motor incomplete
motor function preserved for voluntary anal contraction OR
pt meets sensory incomplete and has motor function more than 3 levels below motor level on either side.
Less than half the muscles below neurologic level have a grade greater than or equal to 3.

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11
Q

ASIA Scale:
D

A

Motor incomplete
C but with half or more of key muscles functions below having a muscle grade of greater than or equal to 3.

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12
Q

ASIA Scale:
E

A

normal

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13
Q

Motor level

A

most caudal key muscles that have muscle strength of 3 or more with the superior segment tested as normal 5.

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14
Q

Motor index scoring

A

testing each key muscle using 0-5 scaling totaling 25 points per extremity for total of 100

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15
Q

Sensory level

A

determined by most caudal dermatome with normal score of 2/2 for pinprick and light touch

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16
Q

Key muscles tested:
C5

A

elbow flexors (biceps, brachialis)

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17
Q

Key muscles tested:
C6

A

wrist extensors (extensor carpi radialis longus and brevis)

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18
Q

Key muscles tested:
C7

A

elbow extensors (triceps)

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19
Q

Key muscles tested:
C8

A

finger flexors (flexor digitorum profundus) to the middle finger

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20
Q

Key muscles tested:
T1

A

small finger abduction (abductor digiti minimi)

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21
Q

Key muscles tested:
L2

A

hip flexors (iliopsoas)

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22
Q

Key muscles tested:
L3

A

knee extensors (quads)

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23
Q

Key muscles tested:
L4

A

DF (anterior tib)

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24
Q

Key muscles tested:
L5

A

long toe extensors (extensor hallucis longus)

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25
Key muscles tested: S1
ankle plantar flexors (gastroc and soleus)
26
Sensory testing for light touch and pinprick
see photo
27
Complications with SCI
DVT ectopic bone orthostatic hypotension pressure ulcers spasticity
28
DVT prevention
prophylactic anticoagulant therapy maintaining positioning schedule ROM proper positioning to avoid excessive venous stasis and use of elastic stockings
29
DVT is suspected then what
no active or passive movement bed rest and anticoagulant therapy
30
Autonomic Dysreflexia
occurs in pts with SCI in T6 or above sudden elevation in BP caused by distended or full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, extreme temp changes, tight clothing or ingrown toenail
31
Symptoms of Autonomic Dysreflexia
HBP, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, vasodilation above level of injury.
32
How to treat Autonomic Dysreflexia
immediately check the catheter lying the patient down is a contraindication potentially check for bowel obstruction pt should receive immediate medical intervention
33
Ectopic bone is aka
heterotrophic ossification
34
Ectopic bone typically occurs where? Symptoms?
larger joints like knees and hips edema, decreased ROM, increased temp of involved joint
35
Orthostatic hypotension is due to ... What is common during early stages of rehab? Decrease of how much systolic BP and how much diastolic BP is considered orthostatic?
loss of sympathetic control of vasoconstriction in combo with absent or severely reduced muscle tone. venous pooling 20 mmHg 10 mmHg
36
Pressure ulcers common areas
coccyx, sacrum, ischium, trochanter, elbows, buttocks, malleoli, scapulae, and prominent vertebrae
37
How often should they change positions to avoid pressure ulcers? How often should weight shift?
2 hours 15-20 min
38
How can spasticity be enhanced? Symptoms?
internal and external sources: stress, decubiti, UTI, bowl or bladder obstruction, temp changes or touch increased tonic stretch reflexes and exaggerated DTRs
39
Bed Mobility levels of assist for High Tetraplegia (C1-C5)
dependent (C1-C4) Moderate to max assist (C5)
40
Bed Mobility levels of assist for mid-level tetra (C6)
minimal assist to mod I with equipment
41
Bed mobility levels of assist for low tetra (C7-C8)
independent
42
Bed mobility levels of assist for paraplegia
independent
43
Transfers level of assist for high tetra (C1-C5)
dependent (C1-C4) max A with level slide board transfer (C5)
44
Transfers level of assist for mid-level tetra (C6)
min A to mod I for slide board transfers dep with w/c loading dep with floor transfers and uprighting w/c
45
Transfers level of assist for low tetra (C7-C8)
mod I to I with level surface slide board Mod A to Mod I with car transfer Max to Mod A with floor transfers and uprighting w/c
46
Transfer level of assist for paraplegia
Indep with level surface and car transfers minA to I with floor transfers and uprighting w/c
47
Weight shift level of assist for high tetra (C1-C5)
setup to Mod I with power recline dep with manual
48
Weight shift level of assist for mid-level tetra (C6)
Mod I with power recline Min A to Mod I with manual
49
Weight shift level of assist for low tetra (C7-C8)
Mod I with side to side, forward lean and depression
50
Weight shift level of assist for paraplegia
Mod I for depression weight shift
51
W/c management level of assist in high tetra (C1-C5)
dependent
52
W/c management level of assist in mid-level tetra (C6)
some assistance
53
W/c management level of assist in low tetra (C7-C8)
may require assistance with cushion adjustment, anti-tip levers, and w/c maintenance
54
W/c management level of assist in paraplegia
independent
55
w/c mobility level of assist in high tetra (C1-C5)
Sup/setup to Mod I on smooth, ramp and rough terrain in power w/c Mod I with manual w/c on smooth surface (C5) Max A to Dep with manual w/c in all other situations
56
w/c mobility level of assist in mid-level tetra (C6)
Mod I in smooth, ramp and rough terrain in power w/c dep to max A up/down curb with power w/c Mod I on smooth surface in manual w/c Mod to min A on ramps and rough terrain with manual w/c max to mod A up/down curbs with manual w/c
57
w/c mobility level of assist in low tetra (C7-C8)
Mod I on smooth, ramp and rough terrain with power w/c. Dep to Max A up/down curb with power w/c. Mod I on smooth surfaces and up/down ramps with manual w/c. Min A to Mod I on rough terrain. Mod to Min A up/down curbs with manual w/c. Dep to Max A up/down steps with manual w/c
58
w/c mobility level of assist in paraplegia
min A to Mod I up/down 6" curbs in manual w/c. Mod I with descending steps with manual w/c. Max to min A to ascend steps with manual w/c.
59
Gait level of assist in paraplegia
exercise only with KAFO household gait with KAFO limited community gait with KAFO or AFO functional community ambulation with or without orthoses
60
ROM/positioning level of assist in high tetra (C1-C5)
dependent
61
ROM/positioning level of assist in mid-level tetra (C6)
mod A to mod I with all
62
ROM/positioning level of assist in low tetra (C7-C8)
Min A to mod I with all
63
ROM/positioning level of assist in paraplegia
indepenent
64
Feeding level of assist in high tetra (C1-C5)
dependent (C1-C4) Min A with adaptive equipment in C5
65
Feeding level of assist in mid-level tetra (C6)
Mod I with adaptive equipment
66
Feeding level of assist in low tetra (C7-C8)
Mod I with adaptive equipment (C7)
67
Feeding level of assist in paraplegia
independent
68
Grooming level of assist in high level tetra (C1-C5)
dependent (C1-C4) Min A with adaptive equipment for face, teeth, makeup/shaving (C5) Max/mod A for assistance for hair grooming (C5)
69
Grooming level of assist in mid-level tetra (C6)
mod I with adaptive equipment
70
Grooming level of assist in low level tetra (C7-C8)
Mod I
71
Grooming level of assist in paraplegia
Independent
72
Dressing level of assist in High tetra (C1-C5)
dependent
73
Dressing level of assist in mid-level tetra (C6)
Mod I for upper body in bed or w/c. Min A with lower body dressing in bed. Moderate A with lower body undressing in bed.
74
Dressing level of assist in low tetra (C7-C8)
Mod I for upper/lower body dressing in bed. Min A with lower body dressing/undressing in w/c (C7). Mod I for upper/lower body dressing and undressing in w/c (C8).
75
Dressing level of assist in paraplegia.
Mod I
76
Bathing level of assist in high tetra (C1-C5)
dependent
77
Bathing level of assist in mid-level tetra (C6)
Min A for upper body bathing and drying. Mod A for lower body bathing and drying. Use of shower or tub chair.
78
Bathing level of assist for low tetra (C7-C8)
Mod I with all using shower or tub chair
79
Bathing level of assist for paraplegia
Mod I with all on tub bench or tub bottom cushion
80
Bowel/bladder problems level of assist for high tetra (C1-C5)
dependent
81
Bowel/bladder problems level of assist for mid-level tetra (C6)
Bladder: Min A for male in bed or w/c Mod A for female in bed Bowel: Mod A with use of equipment
82
Bowel/bladder problems level of assist for low tetra (C7-C8)
Bladder: Mod I for male in bed or w/c Mod I for female in be; Mod A for female in w/c. Bowel: Min A to mod I with use of equipment
83
Bowe/bladder problems for paraplegia
Bladder: Mod I for male and female Bowel: Mod I for male and female
84
Head-hip relationships
when transferring, head to move in opposite direction of hips
85
Myelotomy
severs certain tracts within spinal cord in order to decrease spasticity and improve function
86
Neurectomy
removal of segment of a nerve in order to decrease spasticity and improve function
87
Neurogenic nonreflexive bladder
bladder is flaccid as a result of cauda equina or conus medullaris lesion. sacral reflex arc in damaged
88
Neurogenic reflexive bladder
empties reflexively for a patient with injury above T12. Sacral reflex arc remains intact
89
Paradoxical breathing
abnormal breathing common in tetraplegia Inspiration: abdomen rises and chest pulled inward Expiration: abdomen falls and chest expands
90
Rhizotomy
resection of sensory component of a spinal nerve to decrease spasticity
91
Spinal shock
occurs 30-60 minutes after trauma to spinal cord and can last several weeks. Presents with total flaccidity and loss of all reflexes below level.
92
Tenodesis
tetra do not possess control for grip but utilize the flexed fingers for grip
93
Tenotomy
release of tendon
94
Tetraplegia
cervical spine
95
Paraplegia
thoracic, lumbar, sacral
96
Gait training can be done in those with injury at ___ or lower.
T9

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